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HOUSTON – The
remoteness and resource limitations of spaceflight pose a serious
challenge to astronaut health care. One solution is ultrasound.

Scientists
with the National Space Biomedical Research Institute (NSBRI) have
developed tools that expand the use of ultrasound during spaceflight and
on Earth, especially in rural and underserved locations. These tools
include techniques that streamline training and help remote experts
guide non-physician astronauts to perform ultrasound exams. Ultrasound
can be used to assess numerous conditions – fractured bones, collapsed
lungs, kidney stones, organ damage and other ailments – in space and on
Earth. With an NSBRI grant, they also created a catalog, or atlas, of
“space-normal” imagery of the human body, setting the stage for
astronauts to provide care without consulting a physician on Earth. This
atlas was handed over to NASA earlier this year.

Dr. Scott A.
Dulchavsky, the Roy D. McClure Chairman of Surgery and Surgeon-in-Chief
at the Henry Ford Hospital in Detroit, is the principal investigator of
these projects and is a member of the NSBRI Smart Medical Systems and
Technology Team. “The ultrasound imagery techniques came from space
program constraints of not having a trained radiologist on orbit or
having a CAT scan or an MRI available, forcing us to use ultrasound for
things in which we would not normally use it,” he said. “Also, time
limitations forced us to put some tight brackets around what is
absolutely required for training to be able to obtain a high-quality
ultrasound image and to make some sense out of the image.”

Dulchavsky
and colleagues from NSBRI, NASA, Henry Ford and Wyle Integrated Science
and Engineering Group began their first ultrasound experiment --
Advanced Diagnostic Ultrasound in Microgravity (ADUM) -- by developing
exam techniques for use on the International Space Station (ISS). The
goal was for ISS crewmembers to collect high-quality ultrasound images
to send to the Mission Control Center for analysis. The ADUM research
was split into two projects: NSBRI funded the ground portion of the
research, while NASA supported the flight portion.

The
researchers conducted 80 hours of ultrasound examinations on the ISS and
then sifted through approximately 20,000 images and many hours of video
collected during ISS Expeditions 8 through 12 to create the
“space-normal” atlas. The researchers developed the intuitive ultrasound
guide to give astronauts broader use of ultrasound in additional organ
systems and medical problems that were not part of the ISS experiment.
Dulchavsky said, “ADUM initially utilized telemedicine and
tele-ultrasound operations in which the astronauts were interacting with
researchers and flight controllers on the ground during the
examinations. The ultrasound intuitive guide allows astronauts to
conduct exams when quick communication with an expert is not available
due to distance from Earth or other reasons.”

One of the first to
be trained and to conduct an ultrasound exam in space was former NASA
Astronaut and ISS Expedition 10 Commander Dr. Leroy Chiao. “We
demonstrated on the International Space Station that even non-physicians
can produce diagnostic-quality ultrasound images using remote
guidance,” said Chiao who is chairman of the NSBRI User Panel and a
member of Baylor College of Medicine’s Center for Space Medicine. “These
ultrasound exam techniques and atlas will be increasingly important as
we venture farther and longer into space. Telemedicine using ultrasound
will be an invaluable medical diagnostic tool.”

The level of
skill needed to accurately analyze ultrasound exam results will vary
based on the exam’s goal. “To diagnose a broken bone is relatively
straight-forward. When we were trialing this at my hospital, we trained
the custodial personnel to conduct exams. After about five minutes, they
had a diagnostic accuracy in the high 90s,” Dulchavsky said.
“Alternatively, if you are trying to look at subtle changes in how the
heart functions in zero-gravity after six months, that takes
considerably more expertise, and may take hours or even days of
evaluation to do.”

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As in space, low costs and reduced-resource
consumption make ultrasound an attractive option on Earth, but until
recently, the lack of trained personnel has been an issue. Based on
their research for NSBRI, Dulchavsky and his colleagues have spun off
the techniques for terrestrial use and published The ICU Ultrasound
Pocket Book – a reference guide for conducting examinations.

“The
American College of Surgeons, which is charged with continuing
education of surgeons in our country, saw the methods we developed for
space and has now incorporated these techniques in its ultrasound
training courses for all of the surgeons in the United States,”
Dulchavsky said. “Similarly, medical schools are starting to incorporate
this training for all medical students, not just surgeons.”

The
ultrasound imaging techniques are also being used by athletic trainers
for some professional sports teams and the United States Olympic
Committee to get point-of-care rapid information about athletes’
injuries.

However, it is rural locations, both inside and outside
the United States, that stand to gain the most from the diagnostic
ultrasound capabilities and telemedicine. Dulchavsky has been
collaborating with the World Interactive Network Focused on Critical
UltraSound (WINFOCUS) to train individuals to use ultrasound techniques
in under-served regions.

“The use of ultrasound truly enhances
people's opportunities to access and provide accurate, immediate,
cost-effective health care,” said Dr. Luca Neri, director of the
WINFOCUS Global Ultrasound Program, and scientific chair of the
“Point-of-care Lombardia UltraSound” project at Niguarda Ca’ Granda
Hospital and AREU EMS Public Regional Company in Milan, Italy.
“Particularly, within the resource-scarce communities and health-care
systems, we are successfully building upon the innovative ultrasound and
telecommunication technologies developed by Dr. Dulchavsky for NSBRI
and NASA and integrating their capabilities into the national health and
education systems.

“By empowering local personnel to offer
affordable, immediate, accurate, portable imaging, we facilitate earlier
and more effective diagnosis, treatment and follow-up of patients on a
broader basis and in a more sustainable manner.”

Some of the
countries in which the ultrasound techniques are being implemented to
foster sustainable primary health-care development are Mozambique,
Lesotho, Madagascar, India, Brazil and Nicaragua, with programs planned
in Honduras, Congo and Malaysia. Tele-ultrasound has also been performed
by Dulchavsky’s team on Mount Everest and in the high Arctic Circle.
During the past four years, Dulchavsky and Neri gave regular updates
about ultrasound potentials at the United Nations’ Economic and Social
Council and the Observatory for Cultural and Audiovisual Communication
in the Mediterranean and in the World InfoPoverty conferences in Geneva
and New York.

In addition to Dulchavsky’s work, the NSBRI Smart
Medical Systems and Technology Team portfolio contains projects
developing other innovative ultrasound technologies. One project is
developing an ultrasound system to measure bone density and quality and
accelerate fracture healing. Another project is developing a system for
bloodless tumor removal, internal bleeding treatment and kidney stone
reduction.

This article was first published by the National Space Biomedical Research Institute.

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